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Key House Panel Takes Aim at Medicare Fraud

Posted on Monday, July 30, 2018 12:32 PM

Key members of a House of Representatives subcommittee vowed to attack Medicare fraud saying that there is just too much of it going on.

On Tuesday, July 17th, the Oversight Subcommittee of the House of Representatives Ways and Means Committee held a hearing titled, Combating Fraud in Medicare: A Strategy for Success. Witnesses testifying before the subcommittee included Seto J. Bagdoyan, Director, Forensic Audits & Investigative Service, Government Accountability Office, Gloria L. Jarmon, Deputy Inspector General for Audit Services, Office of Inspector General, U.S. Department of Health and Human Services, and Alec Alexander, Director, Center for Program Integrity, Centers for Medicare and Medicaid Services.

They pointed to the fact that there were $52 million in improper payments made it 2017.  They realize that not all improper payments are fraudulent, but they feel that there is still too much.

In opening for the witnesses, Mr. Bagdoyan listed four steps CMS is taking to combat fraud through the Fraud Reduction Framework; (1) establishing the Center for Program Integrity (CPI) to directly lead antifraud efforts; (2) cultivating an environment conducive to antifraud management; (3) targeting areas of highest risk, such as home health care providers; and (4) establishing monitoring and evaluation mechanisms for program integrity initiatives.

Ms. Jarmon testified that improper payments were present in all health care sectors, however, home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities as recipients of larger improper payments, accounting for 33% of overall estimated improper payments in traditional Medicare in 2017.

Mr. Alexander wants to ensure that access to care is protected while tamping down improper payments and fraud stating that payments should be made to the “right provider for the right amount for the right services.” He listed prior-authorization programs, such as the pre-claim review demonstration for home health, as one means to achieving this goal.

Source: NAHC Report

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